scholarly journals Non-invasive detection of myocardial fibrosis in pediatric heart transplant recipients: The role of cardiovascular magnetic resonance

2017 ◽  
Vol 21 (5) ◽  
pp. e12995 ◽  
Author(s):  
Jonathan H. Soslow ◽  
Justin Godown
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Heart Transplant ◽  
Transplant Recipients ◽  
Non Invasive ◽  
Heart Transplant Recipients ◽  
Pediatric Heart Transplant

Transplant cardiomyopathy

2018 ◽  
pp. 321-328
Author(s):  
Christopher A Miller ◽  
Jennifer H Jordan ◽  
Annalisa Angelini ◽  
W Gregory Hundley ◽  
Matthias Schmitt
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Heart Transplant ◽  
Cardiac Allograft ◽  
Imaging Modalities ◽  
Accurate Assessment ◽  
Transplant Recipients ◽  
Heart Transplant Recipients

Heart transplant recipients present with a unique set of anatomical and pathophysiological considerations. Cardiac allograft disease often presents non-specifically, requiring a low index for further investigation. Accurate assessment with standard imaging modalities can be difficult, and cardiovascular magnetic resonance (CMR) is increasingly requested for further clarification. The anatomy of the transplanted heart, common transplant pathologies, and the role of CMR are described.

scholarly journals Bradycardia in a Pediatric Heart Transplant Recipient: Is It the Sugammadex?

2017 ◽  
Vol 22 (5) ◽  
pp. 378-381 ◽  
Author(s):  
Adele King ◽  
Aymen Naguib ◽  
Joseph D. Tobias
Keyword(s):  
Neuromuscular Blockade ◽  
Heart Transplant ◽  
Acetylcholinesterase Inhibitors ◽  
Heart Transplant Recipient ◽  
Neuromuscular Blocking ◽  
Transplant Recipients ◽  
Pharmacologic Agent ◽  
Heart Transplant Recipients ◽  
Pediatric Heart Transplant

Sugammadex is a novel pharmacologic agent that is used to selectively reverse the effects of the neuromuscular blocking agents rocuronium and vecuronium. Various advantages have been reported when comparing its reversal of neuromuscular blockade to that achieved with acetylcholinesterase inhibitors (neostigmine). In heart transplant recipients, bradycardia may occur following the administration of acetylcholinesterase inhibitors, due to the denervation of the heart. Theoretically, the combination of rocuronium and sugammadex could be advantageous in this clinical scenario to avoid the potential bradycardia resulting from neostigmine administration. We present a 10-year-old male who developed profound bradycardia immediately following the administration of intravenous sugammadex. The options for reversal of neuromuscular blockade in heart transplant recipients is discussed, previous reports of bradycardia following sugammadex are presented, and the role of sugammadex in the bradycardia in our patient is reviewed.

Abstract 15703: Cardiac Magnetic Resonance Imaging Can Non-invasively Detect Rejection in Pediatric Heart Transplant Recipients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Soslow ◽  
Justin Godown ◽  
David Bearl ◽  
Kimberly Crum ◽  
Kristen George-Durrett ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Heart Transplant ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Transplant Recipients ◽  
Native T1 ◽  
Heart Transplant Recipients ◽  
T1 And T2 ◽  
Pediatric Heart Transplant

Introduction: Pediatric heart transplant recipients (PHTx) undergo frequent surveillance endomyocardial biopsies (EMB). Non-invasive screening for acute rejection (AR) could decrease morbidity, improve quality of life, and decrease healthcare costs. Hypothesis: We hypothesized that cardiac magnetic resonance (CMR) extracellular volume (ECV), native T1, and T2 mapping can detect AR in PHTx. Methods: PHTx (n=29) were prospectively enrolled at two sites at time of surveillance EMB or EMB for AR. AR was defined as a clinical change or positive EMB requiring intensification of immunosuppression. Subjects with cardiac allograft vasculopathy (n=3) were excluded; ECV was not measured in 2 subjects without rejection (no IV, poor breathholds). CMR without sedation included standard volumetrics, modified Look-Locker inversion recovery before and after contrast, and T2 mapping. A Wilcoxon rank sum was used to assess for a difference between groups. Results: Median age was 17 y/o (range 9-19). There were 9 subjects with and 17 subjects without AR. Base ECV, mid ECV, 4-ch ECV, and average ECV were increased in AR vs non-rejection (Table 1, Fig 1). Native T1 and T2 times were also increased in patients with AR (Table 1). A cut-off of 29% for mid ECV and 1070ms for mid native T1 identifies all patients with rejection with 6 false positive results in non-rejection (Fig 1) and could potentially decrease the need for EMB by 65%. Conclusions: ECV, native T1, and T2 mapping can non-invasively distinguish between PHTx with and without AR and have potential to decrease the required number of surveillance EMBs.

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